额颞部透明质酸填充致血管栓塞及上睑下垂:病例报告及文献复习

目的探究透明质酸填充注射额颞部导致相关血管栓塞及上睑下垂的原因及防治策略。方法采用透明质酸溶解酶注射治疗,以及输注低分子右旋糖酐、罂粟碱、地塞米松等方法,对额颞部透明质酸注射填充后即刻出现血管栓塞、视力受损、上睑下垂患者进行治疗。结果患者经对症处理,病情得到控制,出院后7 d复查,右上睑恢复正常,视力基本恢复正常。结论额颞部透明质酸填充注射血管栓塞风险仅次于眉间-鼻根区域、鼻唇沟区域等处,出现栓塞时,尽早应用透明质酸酶溶解、扩容扩血管改善循环、局部减压、高压氧治疗及抗感染等急救措施,可预防或控制并发症的产生和进展,最大程度减轻对患者的损害。     

姜黄素对巨噬细胞的极化调节作用研究进展

巨噬细胞是创面愈合和组织修复过程的“总指挥”,对整个愈合过程具有不可替代的指导作用.巨噬细胞在不同微环境中可分别被诱导分化为M1型巨噬细胞和M2型巨噬细胞,前者在创面中能吞噬并清除外源性异物和坏死细胞,促进炎症反应的发生;后者在创面中通过释放各种细胞因子,调节创伤修复,抑制炎症反应的发生.不同极化状态的巨噬细胞在创伤愈合过程中发挥着不同的作用.姜黄素能够促进M0和(或)M1型巨噬细胞向M2型巨噬细胞极化.但至今姜黄素对巨噬细胞极化调节作用机制还尚不完全清楚.深入探讨姜黄素对巨噬细胞的调节机制及作用效应,将为创面愈合提供新的治疗策略和靶点.     

姜黄素对创面愈合作用的影响及其机制的初步探讨

目的 观察姜黄素(Curcumin,Cur)对大鼠皮肤创面愈合作用的影响及其机制.方法 取30只雄性SD大鼠,用6 mm打孔器在每只大鼠背部制作4个直径为6 mm大小创面模型.每只大鼠的每个创面每天施加不同浓度姜黄素(30、15、0mg/mL)及PBS干预创面的愈合.在术后第1、3、7、10、14 d随机取6只大鼠计算各创面愈合速率,采用免疫组织化学法检测各组中不同时间点各创面中血管内皮生长因子(vascular endothlial growth factor,VEGF)、碱性成纤维细胞生长因子(basic fibroblast growth factor,bFGF)表达量,采用免疫荧光法检测各组中不同时间点各创面中M1型及M2型巨噬细胞含量.结果 溶媒剂对创面愈合未见明显影响;与对照组相比,Cur15组及Cur30组创面愈合明显增快;Cur15组及Cur30组术后第7天和第10天创面VEGF免疫组化平均光密度数值均多于相同时间点Cur0组及PBS组(P＜0.05);Cur15组术后第3、7和10天及Cur30组术后第7天和第10天bFGF免疫组化平均光密度数值均多于相同时间点Cur0组及PBS组(P ＜0.05);Cur15组及Cur30组术后第3和7天创面CD68与诱导型一氧化氮合酶(inducible nitric oxide sythase,iNOS)双阳性细胞百分比均少于相同时间点Cur0组及PBS组(P＜0.05);Cur15组术后第3和7天及Cur30组术后第3、7、10和14天创面CD68与精氨酸酶1(arginase-1,Arg-1)双阳性细胞百分比均多于相同时间点Cur0组及PBS组(P＜0.05).结论 Cur能够明显促进创面愈合,其机制可能与Cur对M1与M2型巨噬细胞的极化调节有关;Cur浓度为15 mg/mL时创面愈合速率最快.     

TOLL样受体4拮抗剂干预周围神经损伤后的瓦勒变性

BACKGROUND: The mechanism underlying Wallerian degeneration following peripheral nerve injury is complex. Immune regulation on Wallerian degeneration is beneficial for early repair of perpheral nerve injury. OBJECTIVE: To investigate the effects of Toll-like receptor 4 (TLR4) antagonist on Wallerian degeneration and axonal regeneration after early peripheral nerve injury in rats. METHODS: Fifty male Wistar rats were recruited and randomly divided into treatment group (n=20), model group (n=20) and sham group (n=10). The right sciatic nerves of rats in treatment and model groups were cut and sutured end-to-end, while the sciatic nerves of rats in sham group were only exposed. In the treatment group rats were intravenously injected with 0.15 mg/kg TAK-242 via tail vein 1 hour preoperatively and 7 days postoperatively, and the rats in the other two groups were given intravenous injection of the same volume of normal saline. The sciatic nerves were removed at 24 hours, 3, 4 and 7 days after surgery. RESULTS AND CONCLUSION: Real-time PCR indicated that the mRNA expressions of interleukin-1β and monocyte chemoattractant-1 were significantly increased in the model group compared with the sham group at 24 hours after surgery (both P < 0.001), while the expressions were significantly decreased after TAK-242 injection (both P < 0.001). Immunofluorescence showed that compared with the model group, down-regulated expression of CD68+ and iba1+ cells appeared in the treatment group at 3 days after surgery (P < 0.01, P < 0.05). Luxol fast blue staining revealed that demyelination at the sciatic nerve stump appeared in both model and treatment groups at postoperative 7 days, but myelin debris clearance in the treatment group was significantly reduced compared with the model group (P < 0.05). Hematoxylin-eosin staining showed that a lot of inflammatory cells, Schwann cells and regenerated nerve fibers at the sciatic nerve stump were found in the model group, while there were few inflammatory cells, Schwann cells and regenerated nerve fibers in the treatment group at 7 days after surgery. Immunohistochemistry found that the expression of growth-associated protein-43 in the treatment group was significantly lower than that in the model group at 4 days postoperatively (P < 0.05). Besides, compared with the model group, a significantly decreased sciatic functional index was found in the treatment group at 20, 30 and 40 days after surgery (P < 0.05). These results show that TLR4 antagonists delay early nerve regeneration in rats after sciatic nerve injury probably by inhibiting the TLR4 signaling pathway. 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

A型肉毒毒素联合得宝松治疗甲状腺术后瘢痕的疗效

探究A型肉毒毒素与得宝松联合治疗甲状腺术后瘢痕的有效性及安全性。方法 选择 2020年5月-2021年5月南京医科大学附属常州第二人医院整形美容科收治的60例甲状腺术后瘢痕患者为研 究对象，随机分为对照组和观察组，每组30例。对照组采用得宝松注射治疗，观察组采用A型肉毒毒素联 合得宝松注射治疗，比较两组临床治疗情况、瘢痕情况和不良反应发生情况。结果 观察组瘢痕颜色、 宽度及凸度等临床情况优于对照组；观察组温哥华量表评分、瘢痕宽度、瘢痕评估量表（PSAS）评分 及患者满意度评分均优于对照组（P ＜0.05）；观察组不良反应发生率为3.33%，低于对照组的20.00% （P ＜0.05）。结论 A型肉毒毒素联合得宝松比单用得宝松治疗甲状腺术后瘢痕效果更加理想，安全性较 高，患者满意度高，值得临床应用。